RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01853
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Self-Propelled Field Artillery Systems Mechanic, medically separated for “chronic right wrist pain” with a disability rating of 10%.

CI CONTENTION:  The CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060117	VARD - 20061113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Wrist Pain	5099-5003	10%	Right Wrist Residuals Status Post Scaphoid Fracture, 	5215	10%	20061002	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Right (Dominant) Wrist Pain.  According to service treatment record and MEB narrative summary (NARSUM), the CI underwent right wrist surgery on 6 September 2005 for a percutaneous screw fixation for a scaphoid waist fracture nonunion.  At an occupational therapy evaluation on 12 October 2005, 1 month after the operation and 5 months prior to separation, the CI stated he was happy with the outcome of his operation, was still wearing a splint, was able to perform most tasks independently, but his wife needed to help him hold some things.  Physical examination of the right wrist revealed dorsiflexion to 55 degrees (normal 70), palmar flexion to 35 degrees (normal 80), ulnar deviation to 25 degrees (normal 45) and radial deviation to 10 degrees (normal 20); painful motion was not addressed.  Forearm motion was normal.  X-rays of the wrist showed the fracture was healing well.  

The 23 November 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant right wrist aching made worse by holding in a dependent position.  Pain was also increased with picking up objects heavier than 2 or 3 pounds and shifting gears in the truck he drove in his civilian occupation.  Physical examination showed right wrist tenderness.  The examiner referenced the aforementioned occupational therapy evaluation ROMs.  

At the 2 October 2006 VA Compensation and Pension (C&P) Wrist examination, 7 months after separation, the CI reported right wrist pain with weakness and difficulty holding things.  He was unable to throw a baseball, shift gears in bug trucks and pick up heavy items.  He reported the wrist swelled up with activity.  Physical examination demonstrated dorsiflexion to 65 degrees, palmar flexion to 65 degrees, ulnar deviation to 20 degrees and radial deviation to degrees.  Pain was noted with all motions.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist pain 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the wrist condition 10%, coded 5215 (wrist, limitation of motion), based on the C&P Wrist examination, citing dorsiflexion of the wrist less than 15 degrees and palmar flexion limited in line with the forearm.  The panel noted the maximum rating for limitation of wrist motion (5215) is 10% as adjudicated by the PEB.  There was no wrist ankylosis (5214), no ulnar or radius injuries to utilize any of the long bone codes of the forearm (5210, 5211, 5212), and no evidence of limitation of pronation (5213) to support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right wrist condition.  

BOARD FINDINGS:  In the matter of the right wrist condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011261, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure